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314 Exam 2 > Endocrine > Flashcards

Endocrine Flashcards

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1
Q

The endocrine system is composed of _______ such as ….

A

Glands

  • Hypothalamus
  • Pituitary gland
  • Pineal gland
  • Thyroid/Parathyroid gland
  • Adrenal gland
  • Pancreas
  • Ovaries/Testicles
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2
Q

The hypothalamus secretes __________ which _________

A

Releasing Hormones that tell other glands what to secrete

The hypothalamus is the main gland that produces Releasing Hormone

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3
Q

The Anterior Pituitary produces _________ Which _______

A

Tropic hormones which are signaling molecules that stimulate endocrine glands to produce and release specific hormones

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4
Q

What hormones does the Anterior pituitary release?

A
  • Growth hormone > Bone, Muscle, and organs
  • Prolactin > Breasts
  • LH/FSH > Ovaries and Testes (Estrogen & Progesterone/Testosterone)
  • ACTH > Adrenal cortex (Cortical hormones)
  • TSH > Thyroid gland (Thyroid Hormone)
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5
Q

What Hormones does the Posterior Pituitary Release

A
  • ADH > Kidneys
  • Oxytocin > Breasts and Uterus
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6
Q

What could cause hypopituitarism, and what does hypopituitarism result in?

A

Causes
- Pituitary tumor
- TBI
- Iatrogenic injury (Surgery)
- Inflammatory conditions (TB)

Results in
Decreased Hormone levels which lead to decreased organ function

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6
Q

Causes of Hyperpituitarism

A

Pituitary Tumor
- Prolactinomas (Most common)
- TSHoma (least common)

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7
Q

Where do you find the Adrenal gland?

A

On top of the kidney (Kidneys Hat)

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8
Q

Where is the Adrenal cortex and what does it secrete

A

The adrenal cortex is the outside of the adrenal gland

It secretes Mineralcorticoids (Aldosterone) and Glucocorticoids (Cortisol)

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9
Q

Function of Aldosterone and Cortisol

A

Aldosterone (Mineralocorticoid): Increases sodium absorption, causes potassium excretion

Cortisol (Glucocorticoid): Affects glucose, protein, and fat metabolism, body response to stress, and immune function

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10
Q

Where would you find the adrenal medulla and what does it secrete?

A

The adrenal medulla is inside the adrenal gland

It secretes Epinephrine and Norepinephrine

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11
Q

What causes Addisons Disease/ Renal Insufficiency

A

Caused by damage by damage or dysfunction of adrenal cortex

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12
Q

What does dysfuntion of the adrenal cortex lead to?

A

Diminished production of mineralocorticoids and glucocorticoids –> leading to decreased cortisol and aldosterone

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13
Q

Lab tests to determine Addisons disease

A

Decreased sodium
Increased potassium
Hypoglycemia

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14
Q

Diagnostic test for Addisons disease

A

ACTH stimulation test
- Administer ACTH and measure cortisol production

Primary Problem (Problem with adrenal gland > Cortisol levels do not rise

Secondary Problem (Problem with pituitary) > Cortisol levels rise

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15
Q

Addisons disease signs and symptoms

A

Low Blood pressure
Weight loss

GI Issues
- N/V
- Diarrhea
- Constipation
- Abdominal Pain

Skin
- Vitiligo
- Hyperpigmentation

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16
Q

Adrenal Crisis

A

Acute drop in adrenal corticoids due to sudden discontinuation of glucocorticoid medications or induced by trauma, stress, or infection

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17
Q

Adrenal Crisis Signs and Symptoms

A

Fever
Syncope
Convulsions
Hypoglycemia
Hyperkalemia
Hyponatremia
Severe Vomiting and Diarrhea

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18
Q

Treatment for Adrenal Crisis

A

IV Steroids

Treating Hyperkalemia
- Insulin + Dextrose
- Thiazide Diuretics
- Heart Monitoring

Acidosis
- Sodium Bicarbonate

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19
Q

Cushing syndrome causes

A

More common than Cushing Disease

Caused by exogenous use of glucocorticoids

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20
Q

Cushing Disease cause

A

Due to endogenous causes of increased cortisol

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21
Q

Dangers of overusing prednisone

A
  • Body thinks it is receiving exogenous glucocorticoid > Adrenal gland stops producing cortisol
  • If prolonged occurrence can lead to atrophy of the adrenal gland
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22
Q

What happens if the adrenal gland atrophies and the body needs to produce cortisol?

A

It cant produce necessary cortisol because the receptor sites have become downregulated and the gland is atrophied

  • Leads to adrenal crisis
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23
Q

Main signs of Cushing syndrome

A

Buffalo Hump (Fat Pads)
Moon Face

  • Thinning of hair
  • Increased body and facial hair
  • Purple striae
  • Acne
  • Thin extremities with increased weight gain in abdomen
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24
Cushing diagnostic tests, what are we looking for?
Confirming elevated plasma cortisol levels 1.) Midnight or late-night salivary cortisol 2.) Low-dose dexamethasone suppression test - Administer Dexamethasone -> Should suppress levels of ACTH and endogenous cortisol 3.) 24-h urine cortisol
25
Cushing syndrome Medication treatments
Medications - Ketoconazole: Corticosteroid inhibitor - Mitotane: Destruction of adrenocortical cells (Monitor for hepatotoxicity and hypotension)
26
Cushing syndrome Surgical treatments
- Chemotherapy or radiation of adrenal gland - Primary surgery (Remove adrenal gland) - Secondary surgery (Remove pituitary gland)
27
What should you monitor post procedure for when treating cushings syndrome?
Adrenal Crisis
28
Thyroid gland location
Sits on top of the trachea (Potential for airway issues)
29
What is secreted by the thyroid gland, and what do they regulate?
Secrete Thyroid hormone( T3 and T4) and Calcitonin Which regulates - Overall body metabolism - Energy Production - Tissue use of fats, proteins, and carbs
30
What is necessary to make thyroid hormones
Iodine
31
What does calcitonin do and what is it secreted by?
Secreted by the thyroid - Inhibits the mobilization of calcium from bone - Reduces blood calcium levels
32
What is the most common cause of Hypothyroidism, and explain it
Hashimotos - Autoimmune disorder - Autoantibodies attack the thyroid gland, which leaves the thyroid gland unable to secrete T3 and T4
33
Who is affected more by thyroid disorders and what is important about mild hypothyroidism
Women are often affected more Mild hypothyroidism has vague symptoms > Many go undiagnosed
34
Hypothyroidism Signs and Symptoms
Will show signs of slowed metabolism - Thinner hair, Puffy face, Dry coarse skin, Swelling limbs Lab values - Increased TSH - Decreased T3 and T4
35
What is hypothyroidism called in children and what might you see?
Called Cretinism P-CUMS - Protuding tongue - Coarse facial features - Umbilical hernia - Mental retardation - Short stature
36
How do we treat hypothyroidism, and what education/monitoring is required?
Levothyroxine - Take in the morning without food - Monitor for S/S of hyperthyroidism
37
Myxedema Coma
Not enough thyroid hormone ( MEDICAL EMERGENCY )
38
What can cause Myxedema Coma
(DIET) Drugs Infection Exposure to cold Trauma
39
Consequences of Myxedema coma
Cardiovascular collapse Hypoventilation Hypoglycemia
40
How to treat myxedema coma
IV thyroid hormone (Levothyroxine) Supportive care
41
Most common cause of Hyperthyroidism and what is it?
Graves disease - Autoimmune antibodies > Hypersecrete thyroid hormone
42
What lab tests would you see in Graves' disease (Hyperthyroidism)
Serum TSH: Decreased T3 and T4: Increased Thyroid-stimulating immunoglobulins: Elevated Thyrotropin receptor antibodies
43
What diagnostic procedure would you use for Graves' disease (Hyperthyroidism)? What does it do?
Radioactive Iodine Uptake - Clarifies the size and function of the thyroid - Elevated uptake is indicative of hyperthyroidism - Assess for shellfish allergy or iodine allergy
44
Nursing considerations for Graves' disease
Minimize clients' energy expenditure Provide eye protection Monitor temperature
45
Treatments for Graves' disease
Medication - Methimazole and propylthiouracil - Thionamides (Decrease hormone levels before surgery) Surgery - Thyroidectomy Radioactive Iodine Therapy
46
What precautions do clients need to take when undergoing radioactive iodine therapy?
Waste is hazardous - No sharing toilets - Flush multiple times - Wash clothing separately - Do not share food or drinks - Do not sleep in same room - Stay away from kids and pregnant women
47
What is a Thyroid Storm
AKA: Acute Thyrotoxicosis Sudden surge of large amounts of thyroid hormones > Great increase in body metabolism ( MEDICAL EMERGENCY )
48
Findings with Thyroid Storm
Hyperthermia Hypertension Delerium Vommiting Abdominal Pain Chest Pain Dysryhtmias
49
Treatment for thyroid storm
Treat hyperthermia - Give Acetaminophen, NOT NSAIDs (Increases thyroid levels) - Cool bath Supportive care Thionamides to decrease the synthesis of thyroid hormone - Surgery
50
What are the types of Thyroidectomies
Subtotal : Removal of part of thyroid (Residual thyroid can produce enough hormone) Total: Life long thyroid replacement is needed
51
Post-thyroidectomy considerations
- Support neck on pillows (Avoid extension) - Monitor for hypocalcemia (If parathyroid has been damaged or removed) - Monitor airway (LARYNGEAL STRIDOR) - Risk for edema leading to an occluded airway
52
Thyroid cancer nodule manifestations
Firm, palpable, non-tender mass May have difficulty swallowing May not have alterations in hormone levels
53
Diagnostic procedures for diagnosis of thyroid cancers
Imaging - CT, MRI, PET Fine needle biopsy Radioactive Scan - Hot nodules= HYPERactive (Not usually cancerous) - Cold nodules= HYPOactive nodules (More likely to be cancerous)
54
Where is the parathyroid found and what does it do?
Four pea sized glands found within thyroid tissue Produces and secretes Parathyroid hormone (PTH) in response to HYPOcalcemia = Break down of bone
55
What will HYPOparathyroidism look like
Less Common Similar to s/s of hypocalcemia - Possible side effect of thyroidectomy
56
What does HYPERparathyroidism look like
More common Similar to s/s of hypercalcemia - Surgery is the treatment of choice
57
What is insulins role in the body?
Insulin is the key to the cell - Lets glucose into cells > Treats hyperglycemia - Lets Potassium into cells > Treats hyperkalemia
58
What is the pancreas responsible for in diabetes? What are the pancreatic cells and what do they secrete?
Responsible for regulating blood sugar - Beta Cells: Secrete insulin to move sugar into cells - Alpha cells: Secrete glucagon to convert glycogen into glucose
59
Define metabolic syndrome
A collection of manifestation that lead to diabetes and cardiovascular diseases, like - Abdominal obesity - Insulin resistance - Sedentary lifestyle - Hypertension - High cholesterol
60
What are the 3 types of Diabetes
Type 1: Autoimmune Type 2: Acquired Gestational
61
Type 1 Diabetes is an ________ disorder that will require __________
An autoimmune disorder that will require exogenous insulin for life
62
Type 2 Diabetes
- Cells become insulin resistant - Decreased production of insulin by beta cells - Fat cells are particularly insulin resistant (Need more insulin to have the same effect) - Increased insulin production (Pancreas becomes exhausted, a decrease in function) - Linked to obesity, sedentary lifestyle, genetics
63
When do symptoms for type 1 diabetes begin and what does a client look like?
Symptoms begin in childhood Clinical presentation - Young and thin - Quick onset - New onset > DKA (Diabetic ketoacidosis) - 3Ps (Polyuria, Polyphagia, Polydipsia) - Ketones in urine
64
How do we treat type 1 diabetes
Insulin
65
When do we see more type 2 Diabetes and what are the risk factors?
Seen more in adulthood due to insulin resistance Risk factors - Lifestyle - Obesity - Sedentary - Poor diet - Stress - Genetics
66
What do clients with type 2 diabetes look like clinically? How do we treat it?
Clinical presentation - Overweight - Not quick onset - Rare to see ketones Treatment - Diet and exercise - Oral medications
67
What does A1C measure?
Average blood glucose level
68
Signs of HYPERglycemia
3Ps (Polyphagia, Polyuria, Polydipsia) Dry skin Blurred Vision Delayed wound healing
69
Signs of HYPOglycemia
P-TIRED Pallor/Clammy Tachycardia Irritability Restlessness Excessive Hunger Dizziness
70
Would we rather have a client be hyperglycemic or hypoglycemic? If blood sugar levels are unknown what should we treat for?
Hyperglycemic If blood sugar is unknown treat for hypoglycemia
71
Rule of 15
If glucose is lower than 70 - 15g PO fast-acting sugars (4oz juice, crackers, soda) - Check in 15 minutes - If still below 70, repeat treatment If after 2-3 glucose is still below 70, contact physician
72
Other methods to raise glucose levels than PO
Glucose tablets 1mg Glucagon IM injection Give a protein snack after fast acting sugars to stabilize glucose
73
If glucose levels are below 40
May need IV dextrose 1 ampule of D50
74
At what glucose level does inpatient treatment for hyperglycemia start
150 s/s - 3Ps - Dry mucous membranes - Rapid Weak pulse - Weakness and Malaise Treatment: - Short acting insulin (Novolog, humolog) - Adjust basal-bolus regimen
75
Diabetes Complications
- Arteriosclerosis - Peripheral angiopathy (lack of circulation) - Diabetic retinopathy - Diabetic neuropathy - Autonomic neuropathy - Diabetic nephropathy - Immunosuppression - Poor wound healing
76
What needs to happen to the feet of diabetics
- Clients should assess daily - Toenails cut straight and filed down (Provider) - Providers document foot assessment each visit
77
Why do clients not notice wounds on feet?
Peripheral neuropathy Poor wound healing If infection reaches the bone (Osteomyelitis) > Amputation
78
How does DKA occur
Insufficient insulin r/t untreated T1DM No insulin > Liver starts Gluconeogenesis (using fats and amino acid to make glucose) > Byproduct = Ketones
79
What happens when cells sense high blood sugar
Pull water out of cells into blood bloodstream> Severe cellular dehydration (Life-Threatening)
80
How should patients demonstrate an understanding of the provided education
Teachback method

314 Exam 2 (4 decks)

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